Background Hamstring injuries are the most common muscle injuries in male amateur soccer. Eccentric strength of the hamstrings is recognized as an important modifiable risk factor, leading to the development of preventive exercises such as the Nordic Hamstring Exercise. Objective This study aims to investigate the preventive effect of the Nordic Hamstring Exercise on the incidence and severity of hamstring injuries in male amateur soccer players. Design Cluster-randomized controlled trial with soccer teams as the unit of cluster. Setting Dutch first class amateur field soccer. Participants Male amateur soccer players (mean age 24.5 years, SD 3.8 years) from 40 teams were allocated to intervention (n=309 players) or control group (n=310 players). Risk factor assessment The intervention group was instructed to perform 25 sessions of the Nordic Hamstring Exercise within a period of 13 weeks during the first months of 2013. Both the intervention group and control group performed regular soccer training and were followed for hamstring injury incidence and severity during the calendar year 2013. At baseline, personal characteristics (e.g. age, injury history, field position) were gathered from all participants via questionnaire. Main outcome measurements Primary outcomes are initial and recurrent hamstring injury incidence (number of hamstring injuries) and injury severity (number of days injured). Results Interim analysis after intervention (2 months follow-up) show a total of 2 hamstring injuries in intervention group vs 12 hamstring injuries in control group (χ2=7.5, P<.05). Regarding injury severity, no difference was found between intervention and control group (t=0.3, P=.77). Conclusions Preliminary analyses during the summer break show substantial hamstring injury incidence reduction by incorporating the Nordic Hamstring Exercise in regular training. With a total follow-up of 9 months, final analyses (survival analyses including the number of injuries per 1000 playing hours) will be performed in January 2014.

Background: Interest in patient involvement in research is growing. Research should rather be 'with' or 'by' patients, and not only be 'about' or 'for' patients. Patients' active involvement in research is not self-evident and special efforts have to be made. If we make efforts towards patient involvement, it could contribute to even more relevant projects with an even greater impact. In this paper we describe the process of development of a tool to support patient involvement in research projects. Methods: The tool development was done in a co-creation of experience experts (patients and their parents/ relatives) together with researchers. We used a participatory method in an iterative process comprising three consecutive stages. First, the purpose for the tool was explored, using focus groups. Second, the main ingredients and conceptualization for the tool were determined, using a narrative review. Third, the so-called Involvement Matrix was formalized and finalized using various expert panels. Results: A conversation tool was developed, through which researchers and patients could discuss and explain their roles of involvement in a research project. This tool was formalized and visualized as a 'matrix'. The so-called Involvement Matrix describes five roles (i.e., Listener, Co-thinker, Advisor, Partner, and Decision-maker) and three phases (i.e., Preparation, Execution, and Implementation) and includes a user's guide. Conclusion: The Involvement Matrix can be used prospectively to discuss about possible roles of patients in different phases of projects, and retrospectively to discuss whether roles were carried out satisfactorily. Sharing experiences with the Involvement Matrix and evaluating its impact are the next steps in supporting patient involvement in research.

Incorporating the NHE protocol in regular amateur training significantly reduces hamstring injury incidence, but it does not reduce hamstring injury severity. Compliance with the intervention was excellent.

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AIM The aim of this study was to examine the relationship between gross motor capacity and daily-life mobility in children with cerebral palsy (CP) and to explore the moderation of this relationship by the severity of CP.METHOD Cross-sectional analysis in a cohort study with a clinic-based sample of children with CP (n=116; 76 males, 40 females; mean age 6y 3mo, SD 12mo, range 4y 8mo-7y 7mo) was performed. Gross motor capacity was assessed by the Gross Motor Function Measure (GMFM-66). Daily-life mobility was assessed using the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills Scale (FSS mobility) and Caregiver Assistance Scale (CAS mobility). Severity of CP was classified by the Gross Motor Function Classification System (48% level I, 17% level II, 15% level III, 8% level IV, 12% level V), type of motor impairment (85% spastic, 12% dyskinetic, 3% ataxic), and limb distribution (36% unilateral, 49% bilateral spastic).RESULTS Scores on the GMFM-66 explained 90% and 84% respectively, of the variance of scores on PEDI-FSS mobility and PEDI-CAS mobility. Limb distribution moderated the relationship between scores on the GMFM-66 and the PEDI-FSS mobility, revealing a weaker relationship in children with unilateral spastic CP (24% explained variance) than in children with bilateral spastic CP (91% explained variance).INTERPRETATION In children aged 4 to 7 years with unilateral spastic CP, dissociation between gross motor capacity and daily-life mobility can be observed, just as in typically developing peers.Gross motor capacity is the ability to use large groups of muscles to keep one's balance and change positions (e.g. sitting, standing, walking, running, and jumping). In typically developing children, this ability is well established by the age of 5 years. 1 In children with cerebral palsy (CP), which is the most common motor disorder in childhood (with a prevalence of 2 per 1000 live births), 2 this ability is not fully established, 3 even in children over 5 years of age with the best functional characteristics. 4 In general, gross motor capacity can be considered an important basis for movement activities of daily living or daily-life mobility. In typical development, children's daily-life mobility gradually dissociates from their gross motor capacity as it becomes increasingly determined by other intrinsic (cognitive and personal) and extrinsic (contextual) factors. 1 Both the concept of gross motor capacity and the concept of daily-life mobility are found within the activities domain of the International Classification of Functioning, Disability and Health. 5 Although the two concepts can be distinguished by qualifying them, respectively, as 'capacity' and 'performance', various qualifiers are frequently used interchangeably, causing confusion even within the domain of activities. In the field of motor control, the ambiguity of qualifiers such as 'ability', 'capacity', 'capability', 'skill', and 'performance' has been criticized. 6 In unravelling the complex relationships in the development...

AIM This study aimed to determine the developmental trajectories of social participation, by level of gross motor function and intellectual disability, in a Dutch population of individuals with cerebral palsy (CP) aged 1 to 24 years. METHOD RESULTSThe developmental trajectories for individuals in GMFCS levels I to IV did not significantly differ from each other. For individuals without intellectual disability, the degree of social participation increased with age and stabilized at about 18 years. These individuals reached social participation levels similar to typically developing individuals. The trajectories were significantly less favourable for individuals in GMFCS level V and individuals with intellectual disability.INTERPRETATION Intellectual disability is more distinctive for the development of social participation than GMFCS level. The developmental trajectories will support individuals with CP and their families in setting realistic goals and professionals in optimizing the choice of interventions at an early age.Participation is a multidimensional construct addressing the aspects of social connection, societal inclusion and membership, and personal and societal responsibilities.

AIM The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy (CP). METHOD This longitudinal study included 423 individuals (260 males, 163 females) with CP.The mean age at baseline was 9 years 6 months (SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System (GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure (GMFM-66) at 1-or 2-year intervals between 2002 and 2009. Data were analysed using nonlinear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model (SLM) with a peak and decline model (PDM), followed by estimating limits and rates of gross motor development. RESULTSThe SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I-II vs level IV and for GMFCS levels I-IV vs level V) of gross motor development. INTERPRETATIONThe results validate the existence of five distinct patterns for gross motor development by level of severity of CP.Gross motor function concerns the use of large groups of muscles to maintain balance and change positions, for example sitting, crawling, standing, walking, running, and jumping. These abilities are typically well established by the age of 5 years.1 However, in children with cerebral palsy (CP) gross motor function is generally not fully established by the age of 5 years, nor at older ages. 2 Therefore, the key feature of CP is a disorder in the development of gross motor function, causing activity limitations, notwithstanding the additional disorders that individuals with CP can have. 3 An understanding of how gross motor function of persons with CP develops over time -from early childhood to adulthood -is clinically important for several reasons. First, it helps individuals with CP and their caregivers in understanding the outlook for gross motor function. 4 Second, it helps clinicians to evaluate individual function by making appropriate clinical comparisons with other individuals of a similar age and severity of CP.5 Third, knowledge of gross motor development helps caregivers and clinicians in planning therapies focused on improving gross motor function and, eventually, on improving functioning in daily life activities. 6Specific evidence-based information on gross motor function in persons with CP has been generated in the last two decades. In the 1990s, cross-sectional studies started to show different patterns for gross motor development by the severity of CP. 7 The description of the different patterns was further facilitated using a standardized 66-item test for gross motor function, the Gross Motor Function Measure (GMFM-66), 2 and a validated five-level ...

Physical activity is low in young children with CP and needs to be promoted at an early stage.